Detection of significant liver fibrosis in Chinese psoriasis patients receiving methotrexate: a comparison between transient elastography and liver histology.

INTRODUCTION: Methotrexate (MTX) is effective for treating psoriasis and psoriatic arthritis, but its potential hepatoxicity remains a concern. Liver biopsy, the gold standard for detecting MTX-induced liver injury, is invasive and carries considerable risk. Transient elastography (TE) offers a non-invasive alternative for detecting advanced liver fibrosis. This study investigated the performance of TE in detecting MTX-induced liver fibrosis among Chinese psoriasis patients, compared with liver biopsy. METHODS: This study included adult patients with clinical psoriasis. Liver stiffness measurement using TE was performed in patients receiving MTX. Exclusion criteria were known liver cirrhosis, positive viral hepatitis carrier status, or conditions influencing TE performance. Liver biopsy was performed when liver stiffness was ≥7.1 kilopascals (kPa) or when the total cumulative dose (TCD) of MTX was ≥3.5 g. RESULTS: A total of 228 patients were screened; among 34 patients who met the inclusion criteria, nine (26.5%) had significant liver fibrosis (Roenigk grade ≥3a). The area under the receiver operating characteristic curve was 0.76 (95% confidence interval=0.59-0.93; P=0.021), indicating that TE had satisfactory performance in detecting liver fibrosis. A cut-off value of 7.1 kPa of liver stiffness yielded 100% sensitivity and 68% specificity. Liver fibrosis was not correlated with the TCD of MTX or the duration of MTX use; it was significantly correlated with obesity and diabetes status (body mass index ≥30 kg/m2, waist circumference ≥138 cm, and glycated haemoglobin level ≥7.8%). CONCLUSION: Transient elastography is reliable and superior to the TCD for detecting liver fibrosis in Chinese psoriasis patients receiving MTX. Liver biopsy should be reserved for high-risk patients or patients with liver stiffness ≥11.7 kPa on TE.

A Single-Port Robotic Platform for Laparoscopic Surgery with a Large Central Channel for Additional Instrument.

A new approach to a surgical robotic platform for single incision laparoscopic or natural orifice transluminal endoscopic surgery is presented in this paper This platform allows insertion of up to four instruments including the robotic arms and the camera through a single cannula at the same footprint. After insertion of all instruments, a large central channel of 15 mm diameter is kept clear for the passage of additional laparoscopic instruments, such as passage or retrieval of suture needles, and/or suction irrigators which greatly facilitates the performance of complex surgical procedures. Phantom and animal trials have been performed to evaluate the insertion and retrieval sequences. These important features were made possible by internally-motorized robotic arms with 7 degrees of freedom and with no external mechanical device connections. The whole platform, together with the 3 degrees of freedom from the swivel system that support the cannula, has altogether 10 degrees of freedom to allow the operation of complex surgeries and access to all quadrants of the abdominal cavity. This new single-port robotic platform paves a new development direction for future non-invasive surgery.

An unusual cause of acromegaly.

We report a rare case of acromegaly due to a growth hormone releasing hormone-secreting bronchial carcinoid tumour. A 40-year-old man initially presented with acromegalic features, and was subsequently found to have a large lung mass in the right lower zone on chest X-ray. Right lower lobectomy was performed, and the tumour was confirmed to be a bronchial carcinoid tumour on histology. Resection of the tumour led to normalisation of serum insulin-like growth factor 1 level and growth hormone responses to an oral glucose tolerance test.

Evaluating the safety and efficacy of the 1,440-nm laser in the treatment of photodamage in Asian skin.

BACKGROUND AND OBJECTIVE: As the demand for diminished procedure-associated downtime continues to increase, nonablative fractional laser resurfacing is becoming a more popular intervention in the progression of photoaging. Patients with pigmented skin and a mild degree of photodamage may be particularly suited for a less intensive laser treatment. In this study, we have evaluated the safety and efficacy of a low energy, low density 1,440-nm fractional laser in the treatment of multiple signs of photoaging including dyspigmentation, wrinkling, tissue laxity, enlarged pores, and skin roughness in Asians. STUDY DESIGN/MATERIALS AND METHODS: Ten Chinese subjects with Fitzpatrick skin types III-V and visible signs of photodamage participated in this study. Patients received four treatments at 2-week intervals with a 1,440-nm diode-based fractional laser. Photographs were taken at baseline, 2 weeks after each of the first three treatments and 4 weeks after the final treatment. Images were evaluated independently by two physicians. Clinical improvement and adverse events were analyzed. Discomfort, heat sensation and overall patient satisfaction associated with the procedure were also quantified. RESULTS: In this prospective single-arm study, signs of photoaging were examined after treatment with the 1,440-nm laser. Here we show that a series of four treatments with this device produced a mild improvement in skin texture, pigmentation, and wrinkling. Changes in pore size and skin laxity failed to reach statistical significance. Immediate after-effects of the procedure included erythema and edema which were transient and left no permanent sequela. A significant proportion of patients reported some degree of discomfort during the procedure despite use of a topical anesthetic. One patient developed a discrete, localized area of post-inflammatory hyperpigmentation which completely resolved by the final follow up visit. CONCLUSION: The low energy, low density nonablative 1,440-nm fractional laser produces a mild improvement in select signs of photodamage after four treatments without any long-term adverse effects.

Association between HLA-B*58:01 allele and severe cutaneous adverse reactions with allopurinol in Han Chinese in Hong Kong.

BACKGROUND: Allopurinol has been reported as a common cause of severe cutaneous adverse reactions (SCARs). Recent studies in various populations suggest that HLA-B*58:01 is a strong genetic marker for allopurinol-induced SCAR, especially in populations with a high frequency of HLA-B*58:01. OBJECTIVES: To confirm the association link between HLA-B*58:01 and hypersensitivity reactions attributed to allopurinol use in Han Chinese patients in Hong Kong. METHODS: We performed a case-control study to investigate whether the HLA-B*58:01 allele predisposes to allopurinol-induced SCAR in Han Chinese patients in Hong Kong. The HLA-B*58:01 genotyping was performed in 20 patients with allopurinol-induced SCAR or erythema multiforme major (EMM; n = 1) and in 30 patients tolerant to allopurinol. RESULTS: All of the 19 patients with allopurinol-induced SCAR examined but not the patient with EMM carried HLA-B*58:01 whereas only four (13%) of the control patients had this allele. The positive rate of the HLA-B*58:01 was significantly higher in the cases than in the allopurinol-tolerant control group [odds ratio (OR) 123·5, 95% confidence interval (CI) 12·8-1195·1; P < 1 × 10(-4) ] and was even higher after removal of the patient with EMM (OR 229·7, 95% CI 11·7-4520·4). The sensitivity and specificity of the HLA-B*58:01 allele for prediction of allopurinol-induced SCAR were 100% and 86·7%, respectively. CONCLUSIONS: This study confirmed the strong association between the HLA-B*58:01 and allopurinol-induced SCAR in Hong Kong Han Chinese patients. A screening test for the HLA-B*58:01 allele should effectively reduce the risk for allopurinol-induced SCAR in Chinese populations.

A comparison of Q-switched and long-pulsed alexandrite laser for the treatment of freckles and lentigines in oriental patients.

BACKGROUND: Q-switched (QS) lasers are effective in the treatment of freckles and lentigines in Type I and II skin, with minimal adverse effects. Long pulsed (LP) lasers have been proposed to be more suitable for treatment of darker skin types. OBJECTIVES: To investigate the efficacy and adverse effects of using QS or LP Alexandrite laser for the treatment of freckles and lentigines in Oriental patients. METHODS: A prospective split-face study of 20 Chinese patients who were randomly assigned to undergo a single QS (50 nanosecond) or LP (100 microseconds) laser treatment to either side of their face was carried out. Two blinded physicians assessed clinical efficacy using visual analogue scales of pre- and post-treatment photographs. Subjective assessment was evaluated using questionnaires which detailed the degree of pain, erythema and edema sustained during treatment, and improvement and satisfaction levels at 4, 8, and 12 weeks. RESULTS: There was statistically significant improvement in pigmentation (P < 0.05) in both groups throughout the study, with no statistical difference found between the groups. Postinflammatory hyperpigmentation was more frequently found after QS treatment (22%), compared to LP treatment (6%). Majority of patients reported moderate to marked improvement in pigmentation throughout the study with both pulse widths, and correspondingly high levels of satisfaction rates. More severe pain, erythema and edema were experienced during QS Alexandrite treatment. CONCLUSION: LP Alexandrite is quick and effective, and carries a lower risk of adverse effects than QS Alexandrite, for the removal of freckles and lentigines in darker skin types.

A retrospective analysis of the management of acne post-inflammatory hyperpigmentation using topical treatment, laser treatment, or combination topical and laser treatments in oriental patients.

BACKGROUND: Post-inflammatory hyperpigmentation (PIH) is characterized by an acquired increase in pigmentation secondary to an inflammatory process, and is a commonly observed response to cutaneous injury in Fitzpatrick types III-VI patients. OBJECTIVES: To determine the effectiveness and safety of using topical treatment, laser treatment, or combination topical and laser treatments to treat acne PIH in Oriental patients. METHODS: This is a retrospective study of 34 randomly selected Chinese patients with acne PIH. They were divided into three groups, and treated with topical agents, 595 nm long pulsed dye laser and/or 1064 nm Q-switched Nd:YAG, or combination topical and laser treatments. An independent clinician assessed pre- and post-treatment photographs to determine efficacy and timing to visible and optimum improvement. RESULTS: There was significant global and focal improvement of acne PIH in patients in all three groups. However, no significant difference was found between the groups. An investigator global assessment showed improvement with all treatment modalities, with 70.6% moderate to marked improvement seen in the combination treatment group, compared to 55.6% in the laser only group, and 50% in the topical treatment only group. Visible and optimum improvement was seen by 3 months in majority of patients treated. One patient developed PIH as a result of laser treatment. CONCLUSION: Topical treatment, laser therapy, and combination topical and laser treatments all appear to be effective management strategies for acne PIH in Fitzpatrick types III and IV skin with little complications. Topical agents may be considered as first-line therapy for acne PIH, taking into consideration its effectiveness, ease of use and cost. Combined topical and laser therapy is also effective, and may be considered as second-line treatment.

Are circulating metabolites important in drug-drug interactions?: Quantitative analysis of risk prediction and inhibitory potency.

The potential of metabolites to contribute to drug-drug interactions (DDIs) is not well defined. The aim of this study was to determine the quantitative role of circulating metabolites in inhibitory DDIs in vivo. The area under the plasma concentration-time curve (AUC) data related to at least one circulating metabolite was available for 71% of the 102 inhibitor drugs identified. Of the 80 metabolites characterized at steady state, 78% had AUCs >10% of that of the parent drug. A comparison of the inhibitor concentration/inhibition constant ([I]/K(i)) ratios of metabolites and the respective parent drugs showed that 17 of the 21 (80%) reversible inhibitors studied had metabolites that were likely to contribute to in vivo DDIs, with some metabolites predicted to have inhibitory effects greater than those of the parent drug. The in vivo drug interaction risks associated with amiodarone, bupropion, and sertraline could be identified from in vitro data only, when data pertaining to metabolites were included in the predictions. In conclusion, cytochrome P450 (CYP) inhibitors often have circulating metabolites that contribute to clinically observed CYP inhibition.

Phaeochromocytoma in the Hong Kong Chinese population.

OBJECTIVE: To review the clinical manifestations of phaeochromocytoma in a Hong Kong Chinese population. DESIGN: Retrospective review. SETTING. Five public hospitals in Hong Kong. PATIENTS: Seventeen patients with operated phaeochromocytoma between 1994 and 2003 were reviewed retrospectively. RESULTS: Six patients (35%) were men, 11 (65%) were women. The mean age at presentation was 47 (range, 17-72) years. The diagnosis post-presentation was delayed by 1 to 132 months. Over 70% of the patients had hypertension. The most frequent symptoms were headache (53%), palpitations (53%), and sweating (41%); all these symptoms were present in 24% of the patients. Four (24%) had hereditary phaeochromocytoma/paraganglioma syndrome. The sensitivity of 24-hour urinary catecholamine measurements was 82%. Mean urinary adrenaline and noradrenaline concentrations were respectively 7- and 8-fold greater than the upper reference limits. Computed tomography and metaiodobenzylguanidine scintigraphy were the most widely used means for tumour localisation (sensitivity, 100% and 87% respectively). Approximately 65% of the patients had intra-adrenal tumours; 53% were on right side, 18% were bilateral. All the patients were prescribed phenoxybenzamine (dosage range, 20-120 mg/day) preoperatively. Two thirds of the patients had improved blood pressure 1 year after the operation. No malignancy was reported after a mean follow-up period of 7 years. CONCLUSION: Our series of patients with phaeochromocytomas commonly had a high frequency of normotension and extra-adrenal tumours. A high index of clinical suspicion and appropriate biochemical investigations are necessary to make the diagnosis, especially for patients manifesting adrenal incidentaloma and extra-adrenal lesion.

Sweet Syndrome due to Myelodysplastic Syndrome: Possible Therapeutic Role of Intravenous Immunoglobulin in Addition to Standard Treatment.

We report an 82-year-old lady who developed sudden onset nodular and erythematous lesions and neutrophilia following an episode of urinary tract infection. Skin biopsy confirmed the diagnosis of Sweet syndrome. Response to the use of prednisolone alone was not satisfactory. The skin lesions however showed a sustained response to the regular use of intravenous immunoglobulin (IVIG) and prednisolone was slowly weaned off. Our case highlights the possible therapeutic role of IVIG in managing this condition.

The use of focused ultrasound for non-invasive body contouring in Asians.

INTRODUCTION: Previous studies demonstrated that multiple treatments using focused ultrasound can be effective as an non-invasive method for reducing unwanted localized fat deposits. The objective of the study is to investigate the safety and efficacy of this focused ultrasound device in body contouring in Asians. METHOD: Fifty-three (51 females and 2 males) patients were enrolled into the study. Subjects had up to three treatment sessions with approximately 1-month interval in between treatment. Efficacy was assessed by changes in abdominal circumference, ultrasound fat thickness, and caliper fat thickness. Weight change was monitored to distinguish weight loss induced changes in these measurements. Patient questionnaire was completed after each treatment. The level of pain or discomfort, improvement in body contour and overall satisfaction were graded with a score of 1-5 (1 being the least). Any adverse effects such as erythema, pain during treatment or blistering were recorded. RESULT: The overall satisfaction amongst subjects was poor. Objective measurements by ultrasound, abdominal circumference, and caliper did not show significant difference after treatment. There is a negative correlation between the abdominal fat thickness and number of shots per treatment session. CONCLUSION: Focused ultrasound is not effective for non-invasive body contouring among Southern Asians as compared with Caucasian. Such observation is likely due to smaller body figures. Design modifications can overcome this problem and in doing so, improve clinical outcome.

Laparoscopic excision of choledochal cysts in children: an intermediate-term report.

PURPOSE: To assess the intermediate-term result of the use of the minimally invasive technique in the treatment of choledochal cysts in children. METHODS: This is a retrospective review of all cases of choledochal cyst treated in the tertiary referral centre. The surgical technique is described and all the medical records were reviewed to assess the intraoperative and postoperative complications and follow-up problems. RESULTS: From October 2000 to April 2008, laparoscopic excision and reconstruction were attempted in 37 patients. Laparoscopic surgery was successfully performed in 34. Conversion was required in three patients due to oozing on cyst dissection (two) and bleeding from small bowel mesentry (one) during the early part of the series. Postoperative complications were observed in 15 patients including subhepatic collection (6), bile leakage (3), minor wound infection (4) and prolonged ileus (2). At a mean follow-up of 4.2 years, four patients developed surgical complications including intrahepatic ductal strictures in a type IV cyst (one), stump pancreatitis (one), terminal ileal obstruction from internal herniation (one) and cholangitis (one). The cosmetic result was good in all patients. CONCLUSION: We conclude that laparoscopic excision and reconstruction can be safely performed in children with a choledochal cyst with satisfactory intermediate-term results.

The use of microelectrode array (MEA) to study the protective effects of potassium channel openers on metabolically compromised HL-1 cardiomyocytes.

The microelectrode array (MEA) was used to evaluate the cardioprotective effects of adenosine triphosphate sensitive potassium (K(ATP)) channel activation using potassium channel openers (KCOs) on HL-1 cardiomyocytes subjected to acute chemically induced metabolic inhibition. Beat frequency and extracellular action potential (exAP) amplitude were measured in the presence of metabolic inhibitors (sodium azide (NaN(3)) or 2-deoxyglucose (2-DG)) or KCOs (pinacidil (PIN, a cyanoguanidine derivative, activates sarcolemmal K(ATP) channels) or SDZ PCO400 (SDZ, a benzopyran derivative, activates mitochondrial K(ATP) channels)). The protective effects of these KCOs on metabolically inhibited HL-1 cells were subsequently investigated. Signal shapes indicated that NaN(3) and 2-DG reduced the rate of the sodium (Na(+)) influx signal as reflected by a reduction in beat frequency. PIN and SDZ appeared to reduce both rate of depolarization and extent of the Na(+) influx signals. Pre-treating cardiomyocytes with PIN (0.1 mM), but not SDZ, prevented the reduction of beat frequency associated with NaN(3)- or 2-DG-induced metabolic inhibition. The exAP amplitude was not affected by either KCO. The cardioprotective effect of PIN relative to SDZ may be due to the opening of different K(ATP) channels. This metabolic inhibition model on the MEA may provide a stable platform for the study of cardiac pathophysiology in the future.

Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix.

Fecal soiling or intractable constipation frequently occurs in association with urinary incontinence in children with varying pathologic conditions. To manage double incontinence or the combination of wetting and severe constipation, a Mitrofanoff conduit and a channel for antegrade continence enema is constructed using the appendix by open surgery. We present a video of the first case of robot-assisted laparoscopy for simultaneous reconstruction of a continent urinary diversion using the Mitrofanoff principle and a Malone antegrade continent enema using the divided appendix.

Penile lichen sclerosus after allogeneic stem cell transplantation.

Graft-versus-host disease (GVHD) often complicates allogeneic stem cell transplantation (SCT) and affects mainly the gut, liver, lung and skin. The microscopic morphological features of late-phase sclerodermatous chronic GVHD in the skin, namely epidermal atrophy, lymphoplasmacytic infiltration, dense dermal fibrosis and adnexal atrophy, are histologically indistinguishable from those in sporadic systemic sclerosis, morphoea and the related condition of lichen sclerosus. Mucosal orifices including those of the genitourinary system may be severely affected. We present three SCT recipients with chronic GVHD and severe posthitis leading to phimosis requiring surgery. The excised prepuces showed features of lichen sclerosus including epidermal atrophy and a subepidermal zone of eosinophilic, homogeneous and hyalinized collagen above a band-like lymphoplasmacytic infiltrate. These cases add further evidence to support the notion that penile lichen sclerosus should be included within the expanding sclerodermoid spectrum of late-stage cutaneous chronic GVHD.

Ultrasound bladder measurements in children with severe primary nocturnal enuresis: pretreatment and posttreatment evaluation and its correlation with treatment outcome.

PURPOSE: Results from our previous study demonstrated a high predictive value using ultrasound bladder measurements to identify abnormal bladder function in children with enuresis or urinary tract infection. We prospectively evaluated the role of ultrasound measured bladder parameters for the assessment of bladder dysfunction and posttreatment bladder functional changes (if any), and their correlation with treatment outcome in children with primary nocturnal enuresis. MATERIALS AND METHODS: Patients presenting with severe primary nocturnal enuresis (more than 3 wet nights weekly) were prospectively recruited. At study entry each patient underwent ultrasound, and natural and conventional filling cystometric studies. Bladder volume and wall thickness index was calculated based on ultrasound studies and classified as thick (less than 70), normal (70 to 130) or thin (more than 130). The criteria for diagnosing urodynamic patterns included normal, overactive and underactive detrusor activity. Correlation between the ultrasound measured parameters and urodynamic findings was then evaluated. Patients were treated based on our standardized treatment protocol. Bladder measurements were repeated in those children who had completed treatment. The McNemar test was used for comparing posttreatment changes in bladder measurements corresponding to treatment outcome in different groups, and p values less than 0.05 were regarded as statistically significant. RESULTS: A total of 35 children (23 males, 12 females; mean age 9.03 years) were prospectively recruited. At study entry bladder volume and wall thickness index was normal in 8 patients, less than 70 in 24 and more than 130 in 3. When bladder volume and wall thickness index was correlated with ultrasound 87.5% of the patients with a normal index exhibited a normal bladder pattern on imaging. In addition, 96% of the patients with an index of less than 70 exhibited bladder overactivity on ultrasound. All of the children with a normal index had either a complete or good response to treatment, whereas 62.5% of those with an index of less than 70 did not respond to treatment. On followup bladder dysfunction had resolved in 37.5% of the children with an initial index of less than 70, all of whom had a good response to the treatment. Bladder dysfunction persisted in 62.5% of the patients, all of whom had partial or no response to treatment (p <0.001). CONCLUSIONS: Ultrasound measured bladder parameters correlated well with ultrasound findings, changes in bladder function and treatment outcome in children with primary nocturnal enuresis. This study further confirms that this specially designed ultrasound protocol can provide useful predictive clues that may be helpful in differentiating between various treatment subtypes, guiding clinical management and minimizing the need for invasive urodynamic studies.

A prospective, split face, single-blinded study looking at the use of an infrared device with contact cooling in the treatment of skin laxity in Asians.

BACKGROUND: Although monopolar radiofrequency treatment is effective in the improvement of skin laxity, the pain and cost that are associated with this method suggest the need for alternative treatment options. Recently, an infrared device with contact cooling has been shown to be effective in the treatment of skin laxity, with ultrastructural changes observed that are similar to those that are observed following treatment with a monopolar radiofrequency device. However, no control was included in previous studies. OBJECTIVE: To conduct a prospective, split-face, single-blinded study to look at the efficacy and complications among Asians of treatment for skin tightening with an infrared device with contact cooling. METHOD: Thirteen Chinese women were treated. An infrared device with contact cooling (Titan, Cutera, Brisbane, CA) was used to treat one side of the face and the untreated side served as the control. The treatment was performed twice with a 4-week interval between the treatments and the patients were followed up by subjective assessment using a structured questionnaire 1 and 3 months after the second (and last) treatment. In all cases, pre- and post-treatment clinical photographs were taken. Two independent observers assessed the photographs. RESULTS: Twenty-three percentage of patients reported mild improvement, 15% reported moderate improvement, and 54% reported significant improvement 3 months after their second (and last) treatment. In terms of objective assessment, 41% of patients were identified to have some degree of improvement of the treated side 3 months after their second treatment. Compared with the untreated side, the treated side improved significantly (P = 0.031) at 1 and 3 months after the second treatment. Blistering occurred in one patient, which had resolved completely by the 3-month follow-up visit. CONCLUSION: An infrared device with contact cooling can be used effectively and safely for the treatment of skin laxity, especially in smaller anatomical areas.

Is smaller workspace a limitation for robot performance in laparoscopy?

PURPOSE: Robot or computer assisted laparoscopic surgeries have overcome several impediments of conventional laparoscopy in pediatric urology. However, in our practice we faced difficulties while performing specific tasks using the da Vinci Surgical System in small cavities. Thus, we objectively evaluated the performance of robot assisted laparoscopic skills in different sizes of workspace. MATERIALS AND METHODS: Seven assessors performed 5 different drills in 7 different sizes of cubic boxes (edge size ranging from 40 to 150 mm) with the da Vinci Surgical System. The drills were developed based on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills. Assessor performance was evaluated by 2 reviewers for the drill achievement, and time to completion was recorded. A global score was then calculated for each drill in accordance to 1 assessor and 1 box. RESULTS: There were significant collisions while working with the smaller cubes (edges measuring 40 and 45 mm), preventing the surgeon from performing drills. With difficulty, but without collision, the drills were performed in the 50 and 60 mm size cubes. Drills could be accomplished uniformly with ease in the larger cubes (edge 70 mm and greater). CONCLUSIONS: We found that surgeon ability to perform tasks using the da Vinci Surgical System in a small workspace is restricted. This assessment was confirmed by a statistical analysis of the data collected, demonstrating that with common surgical practice using the da Vinci robot workspace has a major impact on surgeon performance.

Minimal invasive surgery in pediatric solid tumors.

BACKGROUND: There is only limited experience of using the minimally invasive surgery (MIS) technique in resecting pediatric solid tumors. In this paper, we report our experience of using the MIS technique in the management of pediatric solid tumors. METHODS: A retrospective review was undertaken on all children who had undergone MIS for their solid tumors between 1995 and 2005. RESULTS: Over a 10-year period, there were 38 patients who had undergone MIS for tumor resection. The mean age at the time of surgery was 7.5 years (range, 1 day to 15 years). There were 22 ovarian tumors, 4 sacrococcygeal tumors, 3 adrenal tumors, 3 retroperitoneal tumors, 1 kidney tumor, 1 liver mass, 1 intra-abdominal testicular tumor, and 3 intrathoracic masses. Thirty of 38 patients had undergone a successful resection using the MIS technique (78.9%). Eight patients required a conversion to the open procedure because of limited intraperitoneal space in 7 and excessive bleeding in 1. Of the 28 successfully MIS-resected intra-abdominal tumors, 18 required enlargement of the umbilical incision and 5 required an additional Pfannenstiel incision for tumor retrieval. Enlargement of the thoracic port site for specimen retrieval was required in the 2 successfully MIS-resected intrathoracic masses. The mean operation time was 171 minutes (range, 45-275). There was no postoperative complication encountered. On an average follow-up of 3.1 years, there was no recurrence observed, even in the 7 patients with malignant tumors, and all patients with successful MIS tumor excision had good cosmetic results. CONCLUSIONS: With the advance of laparoscopic instruments and techniques, a variety of pediatric solid tumors can be resected safely by the MIS technique. This has the potential benefit of a more rapid postoperative recovery and better cosmetic results. The role of the MIS technique in resecting malignant tumors is uncertain, as the number of cases in the current series is too small to draw any conclusion.